Clinical features

It commonly presents in older women (the ratio is 2-3 to1 – females to males), with a sudden onset of symptoms of weakness and pain in both the shoulder and pelvic limb muscle girdles, usually starting in the shoulder area first.

The onset may be as sudden as occurring overnight or over the period of a week. The areas most affected are the proximal (that is, nearer to the centre of the body) muscles of the neck, upper arms, buttocks and thighs.

Stiffness after inactivity (such as in the early morning) is another important symptom and there may be night pain. The person often complains of having to roll out of bed. The pain and stiffness is often symmetrical, that is, affecting both sides of the body at once. The muscles are tender to the touch but are not wasted.

General feelings of malaise, as well as fever, night sweats, depression, weight loss and anorexia (loss of appetite) may also be present to a variable degree.

Widespread joint aches and pains may be present but anything more severe (such as when active joint swelling is present) should be investigated for other conditions such as rheumatoid arthritis. Myeloma should also be excluded.

Temporal arteritis at some stage affects around 20% of people with Polymyalgia Rheumatica (PMR) and it is essential to diagnose and treat this condition urgently, as it can affect the arteries to the eye and lead to irreversible blindness and also stroke. This is manifested by pain and swelling of the scalp in the temporal area (at the side of the head) and diagnosis is essentially a clinical diagnosis which can be confirmed by temporal artery biopsy.

Amended November 2008